External irradiation and one radium application for carcinoma of the cervix.

Between August 1968 and May 1976 at the Tufts-New England Medical Center, Boston, Massachusetts, 264 patients with carcinoma of the cervix on intact uteri were treated with external irradiation followed by one radium application. Of these patients, 78 presented with Stage 1,126 with Stage II, 51 with Stage III, and 9 with Stage IV disease. In a majority of patients, external irradiation was given with ⁶⁰Co when AP diameter was less than 17 cm, and with a 46 MeV Brown-Boveri Betatron when AP diameter was greater than 17 cm. A whole pelvic dose of 4000 rad was given for tumors smaller than 5 cm in size and 4500 rad for those larger than 5 cm. A dose was then given to the pelvic wall using 4 cm or 5 cm midline blocks. In Stage I disease, tumors of less than 2 cm received no pelvic wall irradiation and tumors greater than 2 cm and Stage HA patients received 1000 rad to both pelvic walls. In Stage IIB and IIIA disease, a dose of 1000 rad was given to the uninvolved pelvic wall and 1500 rad to the involved site. In Stage IIIB disease, after giving 1500 rad to the involved parametria, an additional 500 rad was given with a reduced field to the area of gross tumor in the parametrium. All patients had one radium application for 72 hr 7–14 days after completion of all external irradiation. There were no pelvic failures in Stage I patients, $\text{8}\text{56}$ in Stage IIA, 10/70 in Stage IIB, and $\text{17}\text{52}$ in Stage III. The 5 year no evidence of disease (NED) actuarial survival was 100% in early Stage III (less than 1 cm), 90% in Stage III (greater than 1 cm), 79% in Stage IIA, 58% in Stage IIB, 42% in Stage III and 23% in Stage IV. There was no difference in survival or complications between patients who had tandem and colpostats and those who had protruding tandem.